See discussions, stats, and author profiles for this publication at: https://www.researchgate.

net/publication/327545979

Effect of conventional balance exercises and electronic balance board on elderly

individuals

Article · July 2017

CITATIONS READS

0 1,387

2 authors:

Aditi Khot Deepali Hande

Pravara Institute of Medical Sciences University Pravara Institute of Medical Sciences University
3 PUBLICATIONS   1 CITATION    19 PUBLICATIONS   53 CITATIONS   

SEE PROFILE SEE PROFILE

Some of the authors of this publication are also working on these related projects:

A comoarativ study of yoga and aerobic exercises in obedity and its effect on pulmonary function, Immediate effect of jacobsons progressive muscular Relaxation in
Hypertension View project

Effect of conventional balance exercises and electronic balance board on elderly individuals View project

All content following this page was uploaded by Deepali Hande on 09 September 2018.

The user has requested enhancement of the downloaded file.

International Journal of Multidisciplinary Research and Development

International Journal of Multidisciplinary Research and Development

Online ISSN: 2349-4182, Print ISSN: 2349-5979, Impact Factor: RJIF 5.72
www.allsubjectjournal.com
Volume 4; Issue 7; July 2017; Page No. 505-508

Effect of conventional balance exercises and electronic balance board on elderly individuals
1
Aditi Khot, 2 Deepali Hande
1
BPTh, Department of Community Physiotherapy, Dr APJ Abdul Kalam College of Physiotherapy, PIMS,
Loni (Bk), Ahmednagar, Maharashtra, India
Associate Professor, Department of Community Physiotherapy, Dr. APJ Abdul Kalam College of Physiotherapy, PIMS,
Loni (Bk), Ahmednagar, Maharashtra, India

Abstract
Fall is the external causes of unintentional injury. It is the most common complaint in the old age group which is due to loss of
balance. Physical therapy intervention is effective in minimizing balance instability and reducing the risk of fall. Objective was to
find out the effectiveness of Electronic Balance Board along with Conventional Balance Training (CBT) on the balance
performance in the elderly individuals. 50 participants were involved. Group A were given CBT and Group B were given
Electronic Balance Board Training along with CBT for 3 weeks and the risk of fall and balance were assessed pre and post
intervention then Data analysis was done using unpaired ‘t’ test. Result showed statistically significant improvement in the Group
B as compared to Group A. Conclusion was that electronic balance board along with CBT is more effective in improving balance
than conventional balance exercise in elder individuals.

Keywords: electronic balance board, conventional balance training, elderly, falling risk

1. Introduction negative effect on the socioeconomic status and quality of life

Aging is defined as a process that is genetically determined (QOL) in elderly individuals [3]. ADLs are frequently impaired
and environmentally modulated or it is simply getting old [1]. due to weakness in core muscles such as the rectus abdominis,
No of cells comprising the body decrease, and physical transversus abdominis, and the internal and external oblique
adaptability is gradually lost, ultimately leading to death [1]. It muscles. This results in a lack of ability to reach the objects
is associated with a loss in muscle strength and loss of away from the body [4].
peripheral motor and sensory nerves, loss of both vision and Exercise is an important intervention in the maintenance of
control of the eye through the vestibular and visual cortex. [2] bone health, muscle strength and balance, thereby reducing the
These disabilities, secondary to the normal aging process, can risk of falls. Physical factors that influence falls include
lead to loss of balance and poor gait in the older population [2]. weakening of lower extremity muscular strength, a decrease in
Balance is the ability to maintain an upright posture during gait ability, a reduction in balance ability, and a decrease in
static and dynamic tasks which requires complex interactions sensory motor control. [7]
between peripheral and central factors such as vision, Currently there are many programs that helps to improve
somatosensation, vestibular sensation, motor output, and balance in older adults for e.g. unstable surface balance
musculature [3]. Along with interaction of the nervous and training, gait training, gaze stability exercises, Swiss ball,
musculoskeletal system, balance and postural control also Conventional Balance Exercises etc. Among these
requires interaction between vestibular system, visual system strengthening of muscle power and balance training has
and somatosensory system. Vestibular system sends largely been used as exercise for methods [7]. Conventional
information to the occulomotor nucleus which then triggers physiotherapy, through the training of muscle strength, is
the reflexes such as the Vestibulo-Ocular Reflex (VOR) and described as a satisfactory method to improve functional
the Vestibulo-Spinal Reflex (VSR) that act on visual field limitations of such individuals. Conventional balance training
stabilization thus helps to stabilize the eyes and help to sustain (CBT) exercise includes training the strength and endurance
the postural stability throughout stance and walking[4].Decline maximizing flexibility and postural control has been proven
in VOR instability makes them vulnerable to lose balance effective in improving functional ability in addition to
while walking in community or even during stance phase or reducing the risk of fall in elderly individuals. Strategy
when there would be sudden distraction causing increased training program involving ankle, hip strategy training in
postural sway with higher risk of fall. Gaze stability exercises group of people.
can improve the VOR function. These exercises incorporate MFT (My Fitness Trainer) balance board was created for
vestibular adaptation and substitution exercises. It is therefore skiers and followed by surfers to practice their skills in the off
hypothesized that addition of these exercises in balance season and at night, a balance board is a device that has come
training will prove as aid in elderly having balance impairment to be used for training in all sports and martial arts, physical
[4]
. fitness and for non-athletic purposes. New MFT Balance
Falls and fall related injuries can cause limited mobility and boards and discs feature a unique modular design that is easily
functional decline leading to disability and may have a adaptable for athletics training therapy, rehabilitation, senior

505
International Journal of Multidisciplinary Research and Development

fitness. It was developed by ‘Ewald Aigner’, trainer for the The group B i.e. Electronic Balance Board (EBB) and
Austrain ski team for 5 years. It is used to develop balance, Conventional Balance Training (CBT) were first given
motor co-ordination skills, weight distribution and core training on EBB for 15-20 minutes. The participant’s name,
strength .As the age advanced to evade injurious falls; to age, gender, height (cm) and weight (kg) was entered in the
prevent sports injuries, especially to knee and ankle, data form provided in the EBB software. The subjects were
rehabilitation after injuries to several parts of the body. Use of then explained about the training on EBB, a walker was placed
a balance board that are distant from the athletic purpose of its in front of the balance board for safety purpose to avoid fall of
origin have gradually become more common to expand neural the subject. Primarily forward backward and then side to side
networks that enable the left and right hemispheres of the training was selected for the participant; time was set for the
brain to communicate with each other, thereby increasing its current session. For Forward Backward Balance the Electronic
efficiency to develop sensory integration and cognitive skills Balance Board was placed 45 degree from 90 degree position
in children with developmental disorders [9,10,11]. and for side to side balance the subjects were asked to stand
MFT S3 test is a reliable and valid balance measurement on both his feet opposite to computer screen for visual
system for performance and Sensorimotor regulation during feedback then were asked to shift the COP in form of arrow as
lateral and forward, backward test. The test system consists of per displayed on the monitor as a green colour circular target.
a uniaxial unstable platform with an integrated sensor, which At the end of training, the score was displayed in the screen &
records all discrepancies in the horizontal plane. All function recorded for 30, 45, 60 seconds. After 3 weeks again balance
of center of gravity are measured and transformed into was evaluated by the outcome measures Timed Up and Go
stability, sensorimotor and symmetry indexes to define the Test (TUG), Berg Balance Scale (BBS) and Electronic
individual state of balance. For dynamic standing stability on Balance Board (EBB.MFT®). Then effect of conventional
an uneven support surface, this shows good reliability, balance exercises and exercises on electronic balance board on
objectivity and validity [9, 10, 11]. balance were compared [10].
Physical activity is helpful to counteract these age-related
functional declines & help in prolonging independence in 3. Data Analysis and Result
elderly individuals. Thus balance assessment, training & fall Statistical analysis was carried out utilizing demo version of
prevention in elderly individuals is of major importance and INSTAT software and p value 0.05 is considered as level of
should be incorporated into treatment [7]. significance unpaired ‘t’ test was applied to analyse the data

2. Material and Methods Table 1: Comparison of mean of TUG scores between in CBT and
50 participants using convenient sampling were done. The EBB Group
participants were selected according to the inclusion and Mean ±SD ‘t’ ‘p’
exclusion criteria. The selected participants were evaluated for Result
TUG Pre Post value value
balance on time up and go test, berg balance scale and Extremely
electrical balance Board then divided in two groups i.e. Group Group A 12.339±2.293 11.668±2.269 6.180 <0.0001
Significant
A and Group B. The subjects in Group A were given Extremely
Group B 11.604±1.813 10.558±1.535 9.421 <0.0001
Conventional Balance Exercises and in Group B were given Significant
Electrical Balance Board (EBB.MFT ®) training for 15-20 Group A v/s Group A Post Group B Post Statistically
2.028 0.0482
minutes and Conventional Balance Exercises for 20-30 Group B 11.668±2.269 10.558±1.535 Significant
minutes 4 days per week for 3 weeks.
The group A i.e. Conventional Balance Training (CBT) were
given flexibility exercises, strength training, postural control
exercise and general endurance training.

2.1 Conventional Balance Training (CBT)

1. Flexibility: Calf, hamstring, quadriceps, hip flexors & hip
adductors (15 sec hold and 5 repetitions).
2. Strength: Abdominal (curl ups), spinal extensors (prone
extension), hip abductors (side lying with a weight around
the ankle), hip extensors (in prone), hamstring (prone
knee flexion) and quadriceps (knee extension in high
sitting): all movements are given for 10 repetitions.
3. Postural control: Stepping in all direction, reaching to
limits of stability in different position (kneeling, half
kneeling, standing: on hard surface and foam surface),
step up and down, tandem standing and walking, single
Fig 1: Comparison of mean in post intervention between
limb standing (eyes open and closed). Conventional Balance Training and Electronic Balance Board using
4. Endurance: Walking for 12 minutes at self-selected TUG where t value is 2.028 and p value 0.482 which is statistically
comfortable pace on a level surface Surfaces and general significant.
endurance training.

506
International Journal of Multidisciplinary Research and Development

Table 2: Comparison of mean of BBS scores between CBT and EBB Group.
Mean ±SD
BBS ‘t’ value ‘p’ value Result
Pre Post
Group A 43.640±3.946 47.400±3.416 8.187 <0.0001 Extremely Significant
Group B 42.960±4.108 49.560±3.798 14.402 <0.0001 Extremely Significant
Group A v/s Group A Post Group B Post Statistically
2.114 0.0397
Group B 47.400±3.416 49.560±3.798 Significant

Fig 2: Comparison of mean in post intervention between Conventional Balance Training and Electronic Balance Board using BBS where t value
is 2.114 and p value 0.0397 which is statistically significant.

Table 3: Comparison of mean of EBB compared to the Conventional group in overall outcomes.
Mean ±SD ‘t’ ‘p’
Conventional Balance Training, physical exercises to increase
EBB Result flexor and extensor muscles resistance in general decrease
Pre Post value value
Extremely pain and incapacity improving joint function. Pain, when
Group A 4.148±0.5643 3.808±0.5951 10.396 <0.0001 affecting body weight unload joints, especially the knee, leads
Significant
Extremely to more marked decrease in muscle function and, as a
Group B 4.024±0.5732 3.372±0.5927 11.286 <0.0001
Significant consequence, to decreased balance, gait changes and/or loss of
Group A Group A Post Group B Post functional independence. Progressive resistance training
Statistically
v/s 2.596 0.0125 prevents loss of muscle strength and mass and may also
3.808±0.5951 3.372±0.5927 Significant
Group B improve such parameters, which helps in the acquisition of
better balance [6].
In this study both the groups showed significant improvement
balance and reduction in risk of fall this could be because of
the Electronic Balance Board (EBB.MFT) training. In this
study EBB.MFT® Balance board is a unique modular design
that is used to develop balance, motor coordination skills,
weight distribution as well as core strength. Balance and
equilibrium constitute a complex reflexive response initiated
by three primary sensory system (Vestibular, Visual and
somatosensory) and coordinated by central nervous system.
Until about twenty years ago simple behavioural tests such as
Romberg and Mann test were used to test postural control.
More recently computer posturography has been developed
and evaluated (Turner 1998). These devices allow the
assessment of balance function more exactly, objectively and
Fig 3: Comparison of mean in post between Conventional Balance efficiently [9]. Progress in balance score after interventional
Training and Electronic Balance Board using EBB where t value is period, could be due to training or conditioning improvement
2.596 and p value 0.0125 which is statistically significant. of compensatory postural strategies and increase in neuro
transfer between brain and effector muscle through descending
4. Discussion pathway, facilitation of neural pathway, enhancement of
The present study showed that the intervention given to both vestibulocochlear pathway, sensory motor integration and
the groups was effective in terms of balance and reduction in neuroplasticity. In addition by giving the individual visual
risks of fall, irrespective of the treatment received which was feedback, they become more aware of body displacement and
EBB or Conventional Balance Training (CBT).However, EBB orientation in space, they were able to integrate somatosensory
along with CBT showed more significant improvement as and visual information in relation to stance and movement,
507
International Journal of Multidisciplinary Research and Development

which may recalibrate deficient proprioceptive information 2. Natalia Aquaroni Ricci, Mayra Cristina Aratani, Heloisa
and compensate the Sensorimotor deficit [10-11]. Information Helena Caovilla, Fernando Freitas Ganança. Effects of
concerning body position, gravity, musculoskeletal activity, Conventional Versus Multimodal Vestibular
tactile and visual feedback and other input provides the Rehabilitation on Functional Capacity and Balance
nervous system with the information required to maintain Control in Older People with Chronic Dizziness from
balance during daily activities taking place in an ever Vestibular Disorders: Design of a Randomized Clinical
changing environment and also reducing the fear of fall. Trial.
Several studies have utilized a balance board as a way to 3. Jerrold S. Petrofsky, Maria Cuneo, Russell Dial, et al.
demonstrate functional adaptation of spinal reflex in healthy Core Strengthening and Balance in the Geriatric
and elderly population [8]. Population. 2005; 5(3):423-433.
A study by Richard G. Mynark and David M. Koceja has 4. Tanu Khanna, Sandeep Singh. Effect of Gaze Stability
utilized a balance board as a way to demonstrate functional Exercises on Balance in Elderly. 2014; 13(9)41-48.
adaptation of spinal reflex in healthy and elderly population. 5. Jibi Paul, Mythili E. Comparative Study On The Efficacy
CNS adaptation was related with clinical outcome of Of Strategy Training Program Over Conventional Balance
improved static balance and then provide a direct connection Program For Restoration Of Balance In Patients With
between the sensorimotor system and postural control. A 2008 Parkinson’s Disease. 2013, 1(5):219-26.
review found that balance training may decrease the risk of 6. Lourembam Surbala Parth Trivedi, Ratan Khuran, et al.
acute injury. Pilates versus Conventional Balance Training on
A study done by Snehal K. Patel showed similar results that Functional Balance and Quality of Life in Elderly
Electronic Balance Board as a training method is a useful Individuals. 2014; 2(1B):221-226.
exercise intervention for improvising balance. 7. Bernard Wolf, Weerdt Leuven, et al. Effect Of A Physical
A study done by Kalpita Parab showed similar results that Therapeutic Intervention For Balance Problems In The
progressive stepping exercise along with the Electronic Elderly: A Single-Blind, Randomized, Controlled
Balance Board as a training method was a useful intervention Multicentre Trial. 2001; 15:624-636.
for improving balance performance in geriatrics with 8. WWN Tsang. Virtual reality exercise to improve balance
significant history of fall and imbalance. control in older adults at risk of falling. 2016; 22(1):19-
As seen in the present study, Electronic balance board along 22.
with Conventional exercises can be a useful intervention for 9. Snehal K. Patel, Mahendra L Shende, Subhash M. Khatri.
improving balance performance in older individuals with MFTA New Diagnostic Tool to Check the Balance in a
significant history of fall, imbalance or concern about their Normal Healthy Individuals.2013; 5(6):14-18.
balance. 10. Kalpita Parab, Deepali Hande, Nupoor Kulkarni, Subhash
Khatri. Effectiveness of progressive stepping program on
5. Conclusion: Balance performance in geriatrics: a randomized
The present studies show that electronic balance boards are Controlled trial. 2014; 20(33):51-59
more effective in improving balance than conventional 11. Dildip Khanal, Subhash Khatri, RM Singaravelan and
balance exercises in older individuals. Deepak Anap. Clinical Utility of Electronic Balance
Board and Treadmill Training in Pott’s Paraparesis: A
6. Acknowledgement Case Study. 2013; 2(1):1-5.
Indeed, I am very glad to present this project as a part of my
internship, I wish to express my sincere gratitude to all those
who really helped me with it.
I wish to express my deep gratitude to our Principal Dr.
Subhash Khatri sir and my project guide Dr. Deepali Hande
mam who has helped me to choose this project topic and
provide me with constant guidance and support throughout the
project.
I wish to thank all our professors and our senior colleagues for
their cooperation, tolerance and guidance all throughout this
project.
I wish to thank all our dear friends who have directly or
indirectly helped us in this project and always been our well-
wishers in life.
I would like to bow to THE ALMIGHTY and OUR
PARENTS and ALL FAMILY MEMBERS whose blessings,
love and encouragement has always been a catalyst in all
walks of our life.

7. References
1. Alan Tennant, et al. Charterhouse Principal Research
Fellow, Severity of osteoarthritis in knee joint and
associated disabililty in older adults United Kingdom,
Arthritis and rheumatism. 2005; 51(5):55-62.
508

View publication stats